Cholesterol granuloma of the petrous apex: CT diagnosis.

Lo, Wan-Chak; Solti-Bohman, L.G.; Brackmann, Derald E.; P, Gruskin

doi:10.1148/radiology.153.3.6494466

Cited by 85 publications

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“…7 Cholesterol granulomata occur in about 1 per 2-3 million population each year. 8,10 They frequently cause neurosensory hearing loss or cranial nerve palsies or both, 7,8 but our patient had neither. She also had no history of known antecedents to cholesterol granulomata, including cholesteatoma, otitis media or cerebral bleeding.…”

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confidence: 47%

“…See the animated figure at www.cmaj.ca/cgi/content/full/172/4/ 495/DC1. Most cerebral cholesterol granulomata have not been associated with genetic hypercholesterolemia, 7,8 with only 1 previous case linked to homozygous FH. 9 These lesions arise silently and are thought to occur as a foreign body reaction to cholesterol crystals deposited in or adjacent to the mastoid air cells following blockage of the air cell system, in which negative pressure and hypoxia lead to local tissue and blood cell necrosis.…”

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Cerebral cholesterol granuloma in homozygous familial hypercholesterolemia

Johnson¹,

Findlay²,

Wang³

et al. 2005

Canadian Medical Association Journal

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A 45-year-old Chinese-Canadian woman presented with chemosis of several years' duration. As a teenager the patient had noticed corneal arcus and thickening of her Achilles tendons. At age 20 she was found to have a fasting total cholesterol level of 18.0 (normal < 5.2) mmol/L and a low-density lipoprotein (LDL) cholesterol level of 15.4 (normal < 3.4) mmol/L. On the basis of these findings and a family history of hypercholesterolemia in both parents and premature coronary artery disease in her father, homozygous familial hypercholesterolemia (FH) was diagnosed. The initial treatment was with bile acidbinding resins, followed by the addition of hydroxymethylglutaryl coenzyme A reductase inhibitors, or statins, when she was 29. She has been intolerant of fibrates and niacin, both of which caused rashes. At age 30, angina pectoris necessitated coronary artery bypass grafting, and she has since remained free of cardiovascular symptoms. At age 40, carotid ultrasound imaging, conducted after carotid bruits were detected, revealed more than 95% and 50%-79% stenoses of the left and right carotid arteries respectively. She began taking 325 mg of ASA daily and has remained free of neurologic symptoms. Her total cholesterol level and LDL cholesterol level fell to 10.1 and 8.2 mmol/L respectively after she began taking 80 mg of atorvastatin and 4 g of colestipol daily, and her Achilles tendon xanthomas also shrank over time. Her lipoprotein (a) level was elevated at 0.44 (normal < 0.3) g/L. Her sitosterol level was 2.4 (normal ≤ 5.0) µg/mL, and her homocysteine level was 8.0 (normal < 12.1) µmol/L); her ApoE genotype (ε3/ε3) was also normal. The patient's high-density lipoprotein cholesterol level was 0.8 (normal > 0.9) mmol/L on no lipid therapy and has ranged between 0.6 and 1.1 mmol/L with atorvastatin and colestipol therapy; her triglyceride level was 2.7 (normal < 2.3) mmol/L at baseline and has ranged from 1.4 to 3.6 mmol/L with therapy.A genomic DNA sequence analysis showed that she was homozygous for proline-to-leucine substitution at residue 644 of the LDL receptor known as FH-Zambia 1 or FHGujerat, 2 which has not been reported in Canada. 3 This mutation is associated with slowed maturation and attenuated cell-surface expression of LDL receptors 4 but does not abolish receptor function. Partial LDL receptor function appears to explain the patient's responsiveness to therapy, which was better than expected for most patients with homozygous FH. The addition of 10 mg daily of ezetimibe to the atorvastatin and colestipol therapy lowered the patient's LDL cholesterol level to 6.9 mmol/L. When colestipol was discontinued, this level decreased further to 5.9 mmol/L, which suggests an enhanced response to combination statin-ezetimibe therapy in the absence of bile acid-binding resin. Fig. 1 shows the sites of action of medications taken by the patient. We are considering LDL apheresis to further decrease LDL levels.Ophthalmologic examination revealed bilateral chemosis and conjunctival redness with no ocular hypertension ...

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confidence: 47%

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confidence: 99%

Cerebral cholesterol granuloma in homozygous familial hypercholesterolemia

Johnson¹,

Findlay²,

Wang³

et al. 2005

Canadian Medical Association Journal

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“…Cholesterol granulomata occur in about 1 per 2-3 million population each year 5 . In the region of mastoid air cells, the mucosal swelling blockage of the pneumatic pathways to apical air cell system, leading to hypoxia and further tissue and blood cells necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…The petrous apex is the most intracranial site frequently involved by cholesterol granulomata 2,[5][6][7] , followed by orbital bones 4,8,9 . Further reports indicate that cholesterol granulomas account for 60% of petrous apex lesions 10 .There are cases of xanthomas in the third ventricle, including associated with colloid cyst 11 .…”

Section: Discussionmentioning

confidence: 99%

Cerebral cholesterol granuloma: case report

Mendonça

Peron

Stefani

et al. 2007

Arq. Neuro-Psiquiatr.

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Cholesterol granulomas of the central nervous system are rare lesions and the petrous apex is the intracranial site most frequently involved. Cases of intracranial cholesterol granuloma have been reported associated with familial hypercolesterolemia and high serum lipid levels. With few cases reported in the literature, the pathogenesis of the event is until unclear.The following report shows a case of a young woman with a temporal mass with cholesterol granuloma diagnosed in the pathologic examination. CASEA black 20 year-old woman, presented at our service due to severe progressive headache and drowsiness. Physical and neurologic examination were normal. Neuroimaging showed a heterogeneous cystic mass in the posterior right temporal lobe, extending to the ventricular trigone ( Fig 1A, B, C). A temporal craniotomy was performed, and the lesion was resected completely. The post-operative period was uneventful. Pathologic examination was consistent with cholesterol granuloma. There was no dislipidemia nor familial hypercholesterolemia hystory. At 3-month followup, the patient resumed a normal life, with no complaints. The post-operative image shows no recurrence (Fig 1D).CErEbrAl CholEStErol grAnulomA Key WoRDS: granuloma, foreign-body, cholesterol, brain diseases. granuloma de colesterol cerebral: relato de casoReSUMo -Granulomas de colesterol intracranianos são lesões raras, sendo observados na região do ápice petroso. A ocorrência de granuloma de colesterol intracerebral é um evento incomum. Relata-se o caso de mulher de 20 anos submetida a craniotomia para ressecção de processo expansivo temporal, com exame anátomo-patológico evidenciando um granuloma de colesterol.PAlAvRAS-ChAve: granuloma de corpo estranho, colesterol, doenças cerebrais.

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“…The most commom type of lesion is cholesterol granuloma [1]. The cause of the selesions still remain unknown and small lesions can be assymptomatic.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Endonasal Resection of Cholesterol Granuloma of the Petrous Apex

Colonetti¹

2017

JOENTR

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Submit Manuscript | http://medcraveonline.com asosseptal flap has been used to permitlong-termpatency of drainage site [4]. Material and MethodsA 43years old man presented with 6 month history of intermittent right hemicranial headache and ipsilateral conductive hearingloss. The patient had no historyof head trauma. The MRI demonstrated a large and expansile right petrous apex lesion hyper intense on both T1-and T2-weighted scans, without diffusion restriction or internal contrast enhancement. The CT scan showed and expansile and lyticlesion with surrounded bony erosion (Figures 1-4). Surgical techniqueA medial and unilateral trans sphenoidal trans clival approach with internal carotidartery lateralization combined with transpterygoidinfrapetrous approach was indicated because of the location of the lesion. Team surgery is mandatory when there is manipulation of the internal carotid artery and a risk of vascular injury [5]. Bilateral sphenoidotomies provides more room for instrumentation and allow four-hand surgery by a team of surgeons an otolaryngology and a neurosurgeon, however unilateral sphenoidotomie approach can be a viable option and less invasive alternative. The sinonasal mucosa was de congested with topical epinephrine 1:2000. The partial Volume

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Cholesterol granuloma of the petrous apex: CT diagnosis.

Cited by 85 publications

References 0 publications

Cerebral cholesterol granuloma in homozygous familial hypercholesterolemia

Cerebral cholesterol granuloma in homozygous familial hypercholesterolemia

Cerebral cholesterol granuloma: case report

Endoscopic Endonasal Resection of Cholesterol Granuloma of the Petrous Apex

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